Trinity Ileal resection w narration

A 19 year old male presented with a 3 year history of medically managed Crohn's disease with increasing abdominal pain and intermittent vomiting

MRI showed a fixed stricture of the terminal ileum with gross proximal dilatation

There was approximately a 10 centimeter length of ileum proximal to the ileocecal valve which remained pliable and not grossly involved

The decision was made to preserve the ileocecal valve based on finding 10 cm of relatively uninvolved distal ileum

The 5 millimeter Cool Seal Trinity device can be used to dissect through thick mesentery and create mesenteric windows

When mesentery is very thick, it can be taken in two separate leaflets (one proximal and one distal) while maintaining complete hemostasis

A useful technique for thick mesentery is to make a proximal seal on the mesenteric base and then a more distal seal near the bowel wall, dividing tissue at this level to ensure no incomplete seal and maintain proximal vascular control

The mesentery was almost 2 centimeters thick in this case

By using the 5 mm device for mesenteric division, trocars could be limited to two 5 millimeter ports and one 12 millimeter port, which is cosmetically superior to requiring larger ports for 10 mm sealer or 12 mm stapler

The mesenteric division portion of the operation took approximately 20 minutes with no significant blood loss and no unsealed vessels

The patient weighs approximately 62 kg

EndoGIA tan loads were used to divide the bowel both proximally and distally

The 5 mm device has no heat spread and is immediately cool, allowing manipulation of bowel and surrounding structures using the grasper function without needing to exchange for a different grasping tool

Two loads of the endoGIA were required to completely divide the grossly dilated proximal bowel

A 60 millimeter load of the endoGIA was used to perform the side-to-side anastomosis

The resultant enterotomy was closed with a running 2-0 Vicryl suture

The operation took approximately 90 minutes

The patient was left with an NG tube overnight which was removed the next morning

The patient was started on a clear liquid diet on the 2nd postoperative day

The patient was discharged to home on the 3rd postoperative day

There was no blood loss during the procedure